Valley fever / fungal infection

[jstie]

Our 9-yo gray DSH Lady Z joined our household in May of this year. She was my mom's cat, living in Tucson AZ. Mom had a cascade of health issues and could no longer care for her pets, so Lady Z came to live with us in the Chicago area. A few days ago, I picked her up (and she does not care to be picked up) and felt something scratchy or rough inside the thigh on her left leg. She would NOT let us handle the leg or even look at it. I finally managed to steal a glimpse of a nasty-looking wound, and she had been licking it a lot. Took her to the vet the next day, who sedated her and discovered *multiple* open, weepy lesions / sores on that leg. There had been some spitty altercations with one of our other cats (she is indoors only and always has been), but we never saw anything like a fight that serious, but that's what we figured it must be. Wounds were clipped, cleaned, antibiotics, pain meds, etc. given. However, when we tried to check on and clean the wounds the next day, she went completely ballistic and we simply couldn't do it. We went back to the vet, and this time she found a couple of toes were swollen and painful as well. She took a chest x-ray, to check for "lung-digit syndrome" (lung cancer that first shows as painful lesions on the toes). She did not see a tumor, but there was one area of her lung that just looked slightly cloudy. By this time, I had been Googling lung-digit-syndrome, and in among the images was a cat with awful seeping wounds on its leg just like Z's. Turns out, that is how valley fever shows up in cats, including infiltrates in the lungs. And is endemic in Tucson, where Z had lived her whole life. So I asked my vet...could it be...? She said, absolutely it could be! She called the Valley Fever Institute at the U of AZ, drew blood and urine samples, and we hope to have results maybe Friday. So. Any Arizonans here who have dealt with a diagnosed case of valley fever? Sadly, we have been down the fungus road before with our Pawnee, only she had systemic histoplasmosis (different fungus). So I know to expect 6-12 months of antifungal meds. Z is tolerating the cone of shame amazingly well, is eating, drinking, pretty bright-eyed (the pain meds helped!!). But if anyone has been through this with this particular fungus (aka coccidioidomycosis), I'd like to hear your experience! Thank you... wish us luck.

 

[FeebysOwner]

Hi there. I did a search on this site for previous posts on valley fever. There were a few but most of the members are no longer active. However, I did find one active member who has experience with this - GoldyCat . Hoping they don't mind me 'tagging' them for you.

 

[jstie]

Thanks... I did look for other posts, and found a few where valley fever was suspected, but nothing in detail about a cat actually diagnosed with it. I gather it *is* pretty uncommon, with one cat for every 50 dogs diagnosed. When my vet called the valley fever experts in Tucson, she said the doc she spoke with was "quite excited" to hear about a cat with it. One hopes never to be of exciting interest to one's vet - or doctor. :-( Z is not feeling too good today - we discontinued the pain meds, and I think she's feeling it. Left message asking for another day or two of it till we at least get the lab results. The wounds look better - not so red and angry, but quite weepy. It's not fun at all.

 

[Mighty Orange]

Valley Fever in Cats | Valley Fever Center for Excellence
Valley Fever in Cats: Jasper’s Story - Good Pet Parent

Jasper is a good read.
Good luck this is a difficult infection.

 

[GoldyCat]

You're lucky it was diagnosed so quickly. Valley Fever is common in humans and dogs but rare in cats. It took my vet 3 months to diagnose my Merlin after he developed the open skin lesion.

It took 2 years and a combination of 2 antifungal medications to get his titers down low enough to consider him cured. It also took the full two years for the lesion to close completely, although the last few months it was just a pinpick hole.

Sometimes it takes some experimenting to get the right combination of medications. I hope your vet can figure it out quickly and get your girl on the road to recovery.

 

[jstie]

You're lucky it was diagnosed so quickly. Valley Fever is common in humans and dogs but rare in cats. It took my vet 3 months to diagnose my Merlin after he developed the open skin lesion.

It took 2 years and a combination of 2 antifungal medications to get his titers down low enough to consider him cured. It also took the full two years for the lesion to close completely, although the last few months it was just a pinpick hole.

Sometimes it takes some experimenting to get the right combination of medications. I hope your vet can figure it out quickly and get your girl on the road to recovery.

Thank you so much, GoldyCat, for weighing in! We are still awaiting the lab results. The buprenorphine (pain med) seems to help her a good deal - after the last dose wore off, she got very miserable, depressed, wouldn't eat, etc. So we're equipped with enough for the next several days. She absolutely would NOT let us handle that leg, let alone clean the wounds, though a couple of them look to be scabbing over and closing up. Two are still open and ugly. But she is tolerating the cone very well, so we can keep her from working on them. And today, I successfully got a dose of gabapentin in her, and a couple hours later we were able to restrain her at home and at least get some clean, warm compresses on the two bad wounds. So now I feel like we can manage her supportively until we get the lab results (we will be astonished if they're negative!), and proceed with proper treatment. Poor Lady Z... how did we get so lucky. :-( Thanks for any / all support and tips!

 

[GoldyCat]

jstie have you gotten lab results yet?

 

[jstie]

jstie have you gotten lab results yet?

Yesterday got the preliminary results, which were positive for antibodies. But having lived her whole life in southern Arizona, that was to be expected. Waiting now on the antigen test, to confirm actual infection and how high the levels are. Some of her wounds are healing, but a couple are still ugly. She's tolerating the cone and eating okay, but has lost weight. She is REALLY difficult to handle - goes ballistic on us when we try to clean or even look at the wounds, even on gabapentin. She has a couple lesions on her toes, and an x-ray showed some bone lysis, which isn't good... painful and amputation might be needed. We already know we're not going to do that. So the prognosis isn't great. If she has to put up with meds for a year, with painful wounds and disintegrating toes, we have to decide if we will choose to let her go instead. She's pretty miserable now, and I can't make her suffer more for a long time in the hopes of suppressing this awful thing. The vet at the Arizona center for valley fever told my vet another issue is that some cats start the meds, then have a toxic reaction to the death of the fungal organisms and crash. So we're waiting on the final labs, nursing her along, and have to decide what to do. Poor old girl. Her life hasn't been very good this year. Thank you for asking.

 

[jstie]

Gosh, it’s been almost two years now! FWIW - here’s an update. Lady Z has now been on itraconazole for 18 months: first 6 months twice a day. Retested, her fungal titer had dropped from over 1:128 to 1:8. Her drug levels were very high, so the dose was reduced to once a day for the next 12 months, so as not to blow out her liver. We just retested, and her titer is now 1:2, which is as low as they can measure without actually being negative, and her drug levels are just in the therapeutic range. My vet spoke to THE Valley Fever expert in Arizona about what we do now. She says recurrence rates in cats are high if meds are discontinued. If we reduce the dose, it would drop below therapeutic levels, so we could simply stop them altogether, then watch for recurrent symptoms and retest every 3 months. Or…keep doing what we’re doing. She’s doing great clinically - happy, sound, no skin lesions, etc. We had a cat some years ago with a different fungal infection. After a year of meds, she tested negative, so we stopped. But by then she had gone blind. Still, she did great for several more years…until she developed CKD. And the fungus came roaring back. So…with that history in mind, we’re going to just keep Lady Z on the meds with an annual retest and liver values. She’s no trouble to medicate and if she’s doing so well, why mess with it? Anyway, this is an ugly disease, uncommon in cats, and geographically restricted, so a real problem for a lot of vets to even diagnose and treat. Maybe Lady Z’s story will help another kitty somewhere with a mysterious illness from this rotten fungus…!

 

[fionasmom]

Maybe Lady Z’s story will help another kitty somewhere with a mysterious illness from this rotten fungus…!

Yes, I am sure it will. Thank you so much for updating us and letting us know that you have been successful with the treatment!